Highlights & Basics
- Irritant contact dermatitis is caused by direct toxicity without prior sensitization, and allergic contact dermatitis is a delayed hypersensitivity reaction.
- Results in localized burning, stinging, itching, blistering, redness, and swelling at the area of contact with the allergen or irritant.
- Patch testing may aid identification of the causative agent. Skin biopsy may also be helpful, but may not be able to distinguish between other causes of dermatitis.
- Treatment involves removal of the causative agent, future avoidance of the causative agent, topical treatments, or possibly a short course of oral corticosteroids, phototherapy, or immunosuppressants, depending on the type of contact dermatitis and severity.
- Rarely, contact dermatitis can become generalized, leading to areas of dermatitis in locations distant from the site of contact with the causative agent.
- Other allergic conditions may be triggered by exposure to an allergen, such as allergic rhinitis, asthma, and anaphylaxis.
Quick Reference
History & Exam
Key Factors
occupational history of exposure
history of atopic dermatitis
previous episodes of similar dermatitis
acute onset
affecting hands and face
affecting sun-exposed skin
sparing of non-exposed areas of skin
pruritus
burning
erythema
vesicles and bullae
urticaria
lichenoid lesions
corrosion or ulceration
pustules and acneiform lesions
Other Factors
scaling
lichenification
social history of exposure
persistence of symptoms
crusting
erythema multiforme
cellulitic lesions
leukoderma
hypopigmentation/depigmentation
hyperpigmentation
purpura
miliaria
alopecia
granulomatous lesions
Diagnostics Tests
1st Tests to Order
patch testing
Other Tests to consider
repeated open application test (ROAT) or provocative use test (PUT)
skin biopsy
Treatment Options
acute
irritant contact dermatitis
moisturizer and/or topical corticosteroid + irritant avoidance
allergic contact dermatitis (ACD)
mild to moderate
severe
Definition
Classifications
Types of contact dermatitis
- Irritant contact dermatitis is caused by direct toxicity and can occur in any person without prior sensitization.
- Allergic contact dermatitis is a delayed hypersensitivity reaction, which requires prior sensitization.
Vignette
Common Vignette 1
Common Vignette 2
Other Presentations
Epidemiology
Etiology
Pathophysiology
Images
Diagnostic Approach
History and exam
Irritant contact dermatitis (ICD)
Allergic contact dermatitis (ACD)
Investigations
Risk Factors
History & Exam
Tests
Differential Diagnosis
Atopic dermatitis
Differentiating Signs/Symptoms
- Lesions in atopic dermatitis are generally symmetrically distributed over the flexural areas such as the antecubital fossa or popliteal fossa, less likely to be vesicular, more chronic in nature with seasonal variation, and not as sharply delineated.
- Family history in atopic patients is often positive for other atopic diseases such as hayfever, allergic rhinitis, food allergies, or atopic dermatitis.
Differentiating Tests
- Patch testing may be positive if contact dermatitis and atopic dermatitis coexist in the same patient.
Differentiating Signs/Symptoms
- Lesions in nummular eczema are coin-shaped plaques, with pinpoint vesiculation, and symmetrically distributed, most commonly on the extensor lower extremities.
Differentiating Tests
- Patch testing is negative in case of nummular eczema.
Dyshidrotic eczema
Differentiating Signs/Symptoms
- Dyshidrotic eczema almost exclusively involves the palms and soles, with little to no involvement of the dorsal hands and feet.
Differentiating Tests
- Patch testing is negative in cases of dyshidrotic eczema.
Differentiating Signs/Symptoms
- Well-demarcated erythema in intertriginous areas.
Differentiating Tests
- History and clinical appearance; skin biopsy when uncertain.
Differentiating Signs/Symptoms
- Plaques and pustules on the palms and soles.
Differentiating Tests
- History and clinical appearance; skin biopsy when uncertain.
Scabies
Differentiating Signs/Symptoms
- Burrows and typical distribution on hands, feet, waist, axilla, or groin.
Differentiating Tests
- History and clinical appearance; skin scraping with mineral oil prep when uncertain.
Tinea pedis
Differentiating Signs/Symptoms
- Usually occurs between toes, on the soles, and on the sides of the feet; whereas contact dermatitis is more common on the dorsum of the foot.
Differentiating Tests
- History and clinical appearance; potassium hydroxide prep when uncertain.
Criteria
- +/- doubtful: faint erythema only
- 1+ weak: erythema, papules
- 2+ strong: vesicles, infiltration
- 3+ extreme: bullous
- IR irritant reaction: different types of reactions (soap effect, vesicles, blister, necrosis)
Treatment Approach
Allergic contact dermatitis (ACD)
- High- to mid-potency corticosteroids can be used on thicker-skinned areas such as the torso, scalp, palms, and soles.
- Low-potency corticosteroids or topical calcineurin inhibitors should be used on areas with thinner skin, such as skin folds, neck, and face, to avoid skin atrophy, telangiectasia, hypopigmentation, and striae.
Irritant contact dermatitis (ICD)
Management following resolution of the acute episode
Treatment Options
irritant contact dermatitis
moisturizer and/or topical corticosteroid + irritant avoidance
Primary Options
- hydrocortisone topical
(2.5%) children and adults: apply sparingly to the affected area(s) twice daily
- hydrocortisone topical
- desonide topical
(0.05%) children ≥3 months of age and adults: apply sparingly to the affected area(s) twice daily
- desonide topical
- betamethasone valerate topical
(0.1%) children and adults: apply sparingly to the affected area(s) twice daily
- betamethasone valerate topical
- fluticasone propionate topical
(0.005% or 0.05%) children ≥3 months of age and adults: apply sparingly to the affected area(s) once daily for up to 4 weeks
- fluticasone propionate topical
- betamethasone dipropionate topical
(0.05%) children ≥13 years of age and adults: apply sparingly to the affected area(s) once or twice daily
- betamethasone dipropionate topical
- clobetasol topical
(0.05%) children ≥12 years of age and adults: apply sparingly to the affected area(s) twice daily for up to 2 weeks, maximum 50 g/week
- clobetasol topical
Comments
- After an irritant is determined, the main goals of treatment are avoidance of future exposure and resolution of existing dermatitis.
- Irritant contact dermatitis (ICD) is treated by washing off the irritant as soon as possible and postexposure treatment with thick barrier protecting emollients.[41]
- Moisturizers without fragrance, antibacterials, or urea are preferred as these substances often cause sensitization. In one study, 45.3% of patients with fragrance contact allergy succeeded in finding some scented products that they could tolerate (e.g., by use of ingredient labeling), but a significant proportion had continued skin problems.[42] Cream or ointments are preferable over lotions or gels.
- Topical corticosteroids are also commonly used for ICD, because treatment is often initiated before ICD and allergic contact dermatitis differentiation, but very few studies have been performed to evaluate the effectiveness of topical corticosteroids for treatment of ICD, and the results of these studies are conflicting.[43] However, topical corticosteroids can be used if moisturizers are not effective.
- The potency of the topical corticosteroid used for treatment is determined by the severity and location of the dermatitis.[22] Low-potency corticosteroids include hydrocortisone and desonide and are generally used on the face. Medium-potency corticosteroids include betamethasone valerate and fluticasone propionate and are generally used on the torso. High-potency corticosteroids include betamethasone dipropionate and clobetasol and are generally used on palmoplantar skin.
- Choice of topical corticosteroid depends on site and severity, and may differ between adults and children. For example, an infant with severe dermatitis on the face may require desonide, while an adult with mild dermatitis on the face may require hydrocortisone.
allergic contact dermatitis (ACD)
mild to moderate
topical corticosteroid + allergen avoidance
Primary Options
- hydrocortisone topical
(2.5%) children and adults: apply sparingly to the affected area(s) twice daily
- hydrocortisone topical
- desonide topical
(0.05%) children ≥3 months of age and adults: apply sparingly to the affected area(s) twice daily
- desonide topical
- betamethasone valerate topical
(0.1%) children and adults: apply sparingly to the affected area(s) twice daily
- betamethasone valerate topical
- fluticasone propionate topical
(0.005% or 0.05%) children ≥3 months of age and adults: apply sparingly to the affected area(s) once daily for up to 4 weeks
- fluticasone propionate topical
- betamethasone dipropionate topical
(0.05%) children ≥13 years of age and adults: apply sparingly to the affected area(s) once or twice daily
- betamethasone dipropionate topical
- clobetasol topical
(0.05%) children ≥12 years of age and adults: apply sparingly to the affected area(s) twice daily for up to 2 weeks, maximum 50 g/week
- clobetasol topical
Comments
- Severity is dependent on the distribution of ACD, the amount of distress it causes the patient, and exam findings. Mild ACD is characterized with slight erythema or scaling, moderate ACD by induration, and severe ACD by presence of bullae/vesicles.
- After an allergen is determined, the main goals of treatment are avoidance of future exposure and resolution of existing dermatitis.
- Topical corticosteroids are the main treatment for ACD.
- Choice of vehicle (i.e., gel, solution, cream, ointment) depends on the clinical picture, patient preference, and location of dermatitis. Scalp dermatitis is best treated with a liquid or gel while hand dermatitis is best treated with an ointment. The vehicle may also affect corticosteroid potency; ointments tend to be more potent than their cream, gel, or solution equivalents.
- Low-potency corticosteroids include hydrocortisone and desonide and are generally used on the face. Medium-potency corticosteroids include betamethasone valerate and fluticasone propionate and are generally used on the torso. High-potency corticosteroids include betamethasone dipropionate and clobetasol and are generally used on palmoplantar skin.
- Choice of topical corticosteroid depends on site and severity, and may differ between adults and children. For example, an infant with severe dermatitis on the face may require desonide, while an adult with mild dermatitis on the face may require hydrocortisone.
- Reassess patients for improvement after 1-2 weeks of treatment, to determine if a higher-potency corticosteroid is needed, or if the patient can be switched to a lower-potency corticosteroid or stop treatment, to avoid cutaneous adverse effects.
- Patients can develop ACD to topical corticosteroids, especially with prolonged use. Consider this in patients whose dermatitis worsens with topical corticosteroid therapy.
- Prevention of occupational poison ivy, oak, or sumac dermatitis is a major concern for outdoor workers.[39]
topical calcineurin inhibitor or topical PDE4 inhibitor + allergen avoidance
Primary Options
- tacrolimus topical
(0.03%) children ≥2 years of age and adults: apply to the affected area(s) twice daily; (0.1%) children ≥15 years of age and adults: apply to the affected area(s) twice daily
- tacrolimus topical
- pimecrolimus topical
(1%) children ≥2 years of age and adults: apply to the affected area(s) twice daily
- pimecrolimus topical
- crisaborole topical
(2%) children ≥3 months of age and adults: apply to the affected area(s) twice daily
- crisaborole topical
Comments
- Topical calcineurin inhibitors (tacrolimus or pimecrolimus) or phosphodiesterase 4 (PDE4) inhibitors (e.g., crisaborole) can be used as second-line therapy for mild to moderate ACD, when other prescription topical treatments fail or are not indicated.
- Topical calcineurin inhibitors are useful in thin-skinned areas, where use of an equivalent-potency topical corticosteroid may lead to skin atrophy, telangiectasia, hypopigmentation, and striae. Pimecrolimus and tacrolimus are effective in nickel-induced ACD, but pimecrolimus cream was not effective for the treatment of Toxicodendron oleoresin ACD.[36] [37] [38]
phototherapy + allergen avoidance
Comments
- Used for patients with contact dermatitis resistant to treatment with topical and oral corticosteroids; patients in whom topical corticosteroids are ineffective and oral corticosteroids are contraindicated; and patients who cannot avoid repeated exposure to the causative allergen or irritant.
- Broadband UV-B (BUVB) and psoralen plus ultraviolet-A (PUVA) are effective in the treatment of contact dermatitis. They may cause phototoxic reactions, especially with PUVA. PUVA is effective in hand dermatitis.[5]
- Dosing is based on the specific light source and patient skin type.
severe
topical corticosteroid + allergen avoidance
Primary Options
- hydrocortisone topical
(2.5%) children and adults: apply sparingly to the affected area(s) twice daily
- hydrocortisone topical
- desonide topical
(0.05%) children ≥3 months of age and adults: apply sparingly to the affected area(s) twice daily
- desonide topical
- betamethasone valerate topical
(0.1%) children and adults: apply sparingly to the affected area(s) twice daily
- betamethasone valerate topical
- fluticasone propionate topical
(0.005% or 0.05%) children ≥3 months of age and adults: apply sparingly to the affected area(s) once daily for up to 4 weeks
- fluticasone propionate topical
- betamethasone dipropionate topical
(0.05%) children ≥13 years of age and adults: apply sparingly to the affected area(s) once or twice daily
- betamethasone dipropionate topical
- clobetasol topical
(0.05%) children ≥12 years of age and adults: apply sparingly to the affected area(s) twice daily for up to 2 weeks, maximum 50 g/week
- clobetasol topical
Comments
- Severity is dependent on the distribution of ACD, the amount of distress it causes the patient, and exam findings. Mild ACD is characterized with slight erythema or scaling, moderate ACD by induration, and severe ACD by presence of bullae/vesicles.
- After an allergen is determined, the main goals of treatment are avoidance of future exposure and resolution of existing dermatitis.
- Topical corticosteroids are the main treatment for ACD.
- Choice of vehicle (i.e., gel, solution, cream, ointment) depends on the clinical picture, patient preference, and location of dermatitis. Scalp dermatitis is best treated with a liquid or gel while hand dermatitis is best treated with an ointment. The vehicle may also affect corticosteroid potency; ointments tend to be more potent than their cream, gel, or solution equivalents.
- Low-potency corticosteroids include hydrocortisone and desonide and are generally used on the face. Medium-potency corticosteroids include betamethasone valerate and fluticasone propionate and are generally used on the torso. High-potency corticosteroids include betamethasone dipropionate and clobetasol and are generally used on palmoplantar skin.
- Choice of topical corticosteroid depends on site and severity, and may differ between adults and children. For example, an infant with severe dermatitis on the face may require desonide, while an adult with mild dermatitis on the face may require hydrocortisone.
- Reassess patients for improvement after 1-2 weeks of treatment, to determine if a higher-potency corticosteroid is needed, or if the patient can be switched to a lower-potency corticosteroid or stop treatment, to avoid cutaneous adverse effects.
- Patients can develop ACD to topical corticosteroids, especially with prolonged use. Consider this in patients whose dermatitis worsens with topical corticosteroid therapy.
oral corticosteroid + allergen avoidance
Primary Options
- prednisone
children and adults: 0.5 to 1 mg/kg/day orally
- prednisone
Comments
- Used in severe ACD or ACD due to Toxicodendron species (poison ivy).
- Prednisone is the oral corticosteroid of choice. Requires hydroxylation in the liver for conversion to active form, so reduced efficacy may be seen in patients with liver disease.
- Taper dose over a 2- to 3-week course.
phototherapy + allergen avoidance
Comments
- Used for patients with contact dermatitis resistant to treatment with topical and oral corticosteroids; patients in whom topical corticosteroids are ineffective and oral corticosteroids are contraindicated; and patients who cannot avoid repeated exposure to the causative allergen or irritant.
- Broadband UV-B (BUVB) and psoralen plus ultraviolet-A (PUVA) are effective in the treatment of contact dermatitis. They may cause phototoxic reactions, especially with PUVA. PUVA is effective in hand dermatitis.[5]
- Dosing is based on the specific light source and patient skin type.
systemic immunosuppressant + allergen avoidance
Primary Options
- azathioprine
children and adults: consult specialist for guidance on dose
- azathioprine
- cyclosporine modified
children and adults: consult specialist for guidance on dose
- cyclosporine modified
- mycophenolate mofetil
children and adults: consult specialist for guidance on dose
- mycophenolate mofetil
Comments
- Cyclosporine, mycophenolate, and azathioprine can be used for the treatment of refractory contact dermatitis when oral corticosteroids are contraindicated and phototherapy is not available or is ineffective.[40]
- If possible, continued allergen avoidance is advised.
contact dermatitis
allergen/irritant avoidance ± prophylactic skin protectants
Comments
- Quaternium-18-bentonite lotion (Organoclay) is used for the prevention of allergic contact dermatitis from Toxicodendron species oleoresin. Recommend application 15 minutes before anticipated exposure. One clinical trial suggested that the application of topical quaternium-18 bentonite lotion 15 minutes prior to contact with poison ivy can prevent or reduce the severity of dermatitis.[45] Washing with dish soap and scrubbing in one direction within 2 hours of contact can also reduce oleoresin absorption and decrease the severity of dermatitis.[46]
- Dimethicone-containing barrier cream is used for the prevention of irritant contact dermatitis (ICD).[47] Recommend application prior to anticipated exposure.
- Apply white soft paraffin to areas affected by ICD or areas that may come into contact with an irritant or allergen. For the prevention and treatment of all types of contact dermatitis.
Emerging Tx
Janus kinase (JAK) inhibitors
Dupilumab
Prevention
Secondary Prevention
Follow-Up Overview
Prognosis
Poor prognostic factors
Monitoring
Complications
Citations
Johnston GA, Exton LS, Mohd Mustapa MF, et al. British Association of Dermatologists' guidelines for the management of contact dermatitis 2017. Br J Dermatol. 2017 Feb;176(2):317-29.[Abstract][Full Text]
Johansen JD, Aalto-Korte K, Agner T, et al. European Society of Contact Dermatitis guideline for diagnostic patch testing: recommendations on best practice. Contact Dermatitis. 2015 Oct;73(4):195-221.[Abstract][Full Text]
Fonacier L, Bernstein DI, Pacheco K, et al; American Academy of Allergy, Asthma & Immunology; American College of Allergy, Asthma & Immunology; Joint Council of Allergy, Asthma & Immunology. Contact dermatitis: a practice parameter - update 2015. J Allergy Clin Immunol Pract. 2015 May-Jun;3(3 Suppl):S1-39.[Abstract][Full Text]
1. Scheinman PL, Vocanson M, Thyssen JP, et al. Contact dermatitis. Nat Rev Dis Primers. 2021 May 27;7(1):38.[Abstract]
2. Alinaghi F, Bennike NH, Egeberg A, et al. Prevalence of contact allergy in the general population: a systematic review and meta-analysis. Contact Dermatitis. 2019 Feb;80(2):77-85.[Abstract][Full Text]
3. Pesonen M, Jolanki R, Larese Filon F, et al. Patch test results of the European baseline series among patients with occupational contact dermatitis across Europe: analyses of the European Surveillance System on Contact Allergy network, 2002-2010. Contact Dermatitis. 2015 Mar;72(3):154-63.[Abstract]
4. Health and Safety Executive (UK). Work-related skin disease in Great Britain, 2022. November 2022 [internet publication].[Full Text]
5. Johnston GA, Exton LS, Mohd Mustapa MF, et al. British Association of Dermatologists' guidelines for the management of contact dermatitis 2017. Br J Dermatol. 2017 Feb;176(2):317-29.[Abstract][Full Text]
6. Silverberg JI, Hou A, Warshaw EM, et al. Age-related differences in patch testing results among children: analysis of North American Contact Dermatitis Group data, 2001-2018. J Am Acad Dermatol. 2022 Apr;86(4):818-26.[Abstract]
7. Belloni Fortina A, Cooper SM, Spiewak R, et al. Patch test results in children and adolescents across Europe: analysis of the ESSCA network 2002-2010. Pediatr Allergy Immunol. 2015 Aug;26(5):446-55.[Abstract]
8. Borok J, Matiz C, Goldenberg A, et al. Contact dermatitis in atopic dermatitis children: past, present, and future. Clin Rev Allergy Immunol. 2019 Feb;56(1):86-98.[Abstract]
9. Belsito DV. Occupational contact dermatitis: etiology, prevalence, and resultant impairment/disability. J Am Acad Dermatol. 2005 Aug;53(2):303-13.[Abstract]
10. Diepgen TL, Ofenloch RF, Bruze M, et al. Prevalence of contact allergy in the general population in different European regions. Br J Dermatol. 2016 Feb;174(2):319-29.[Abstract]
11. Deleo VA, Alexis A, Warshaw EM, et al. The association of race/ethnicity and patch test results: North American Contact Dermatitis Group, 1998-2006. Dermatitis. 2016 Sep-Oct;27(5):288-92.[Abstract][Full Text]
12. Foschi CM, Tam I, Schalock PC, et al. Patch testing results in skin of color: a retrospective review from the Massachusetts General Hospital contact dermatitis clinic. J Am Acad Dermatol. 2022 Aug;87(2):452-4.[Abstract][Full Text]
13. English JS. Current concepts of irritant contact dermatitis. Occup Environ Med. 2004 Aug;61(8):722-6.[Abstract][Full Text]
14. DeKoven JG, Warshaw EM, Reeder MJ, et al. North American Contact Dermatitis Group patch test results: 2019-2020. Dermatitis. 2023 Mar-Apr;34(2):90-104.[Abstract]
15. Victor FC, Cohen DE, Soter NA. A 20-year analysis of previous and emerging allergens that elicit photoallergic contact dermatitis. J Am Acad Dermatol. 2010 Apr;62(4):605-10.[Abstract][Full Text]
16. Johansen JD, Aalto-Korte K, Agner T, et al. European Society of Contact Dermatitis guideline for diagnostic patch testing: recommendations on best practice. Contact Dermatitis. 2015 Oct;73(4):195-221.[Abstract][Full Text]
17. Thyssen JP, Maibach HI. Drug-elicited systemic allergic (contact) dermatitis - update and possible pathomechanisms. Contact Dermatitis. 2008 Oct;59(4):195-202.[Abstract]
18. Ruff CA, Belsito DV. The impact of various patient factors on contact allergy to nickel, cobalt, and chromate. J Am Acad Dermatol. 2006 Jul;55(1):32-9.[Abstract]
19. Young K, Yu JJ. Hand leukoderma following allergic contact dermatitis from rubber gloves in a health care worker. Contact Dermatitis. 2021 Sep;85(3):369-70.[Abstract]
20. Farsani TT, Jalian HR, Young LC. Chemical leukoderma from hair dye containing para-phenylenediamine. Dermatitis. 2012 Jul-Aug;23(4):181-2.[Abstract]
21. Gordon S, LaTorre A, Witman P. Persistent pediatric contact leukoderma after exposure to butterfly electrocardiogram back pad: a report of three cases. Pediatr Dermatol. 2013 Nov-Dec;30(6):e169-71.[Abstract]
22. Fonacier L, Bernstein DI, Pacheco K, et al; American Academy of Allergy, Asthma & Immunology; American College of Allergy, Asthma & Immunology; Joint Council of Allergy, Asthma & Immunology. Contact dermatitis: a practice parameter - update 2015. J Allergy Clin Immunol Pract. 2015 May-Jun;3(3 Suppl):S1-39.[Abstract][Full Text]
23. Mowad CM. Patch testing: pitfalls and performance. Curr Opin Allergy Clin Immunol. 2006 Oct;6(5):340-4.[Abstract]
24. Jacob SE, McGowan M, Silverberg NB, et al. Pediatric contact dermatitis registry data on contact allergy in children with atopic dermatitis. JAMA Dermatol. 2017 Aug 1;153(8):765-70.[Abstract][Full Text]
25. Dickel H, Kreft B, Kuss O, et al. Increased sensitivity of patch testing by standardized tape stripping beforehand: a multicentre diagnostic accuracy study. Contact Dermatitis. 2010 May;62(5):294-302.[Abstract]
26. Dickel H, Geier J, Kreft B, et al. Comparing reliabilities of strip and conventional patch testing. Contact Dermatitis. 2017 Jun;76(6):342-9.[Abstract]
27. Owen JL, Vakharia PP, Silverberg JI. The role and diagnosis of allergic contact dermatitis in patients with atopic dermatitis. Am J Clin Dermatol. 2018 Jun;19(3):293-302.[Abstract][Full Text]
28. Hamann CR, Hamann D, Egeberg A, et al. Association between atopic dermatitis and contact sensitization: a systematic review and meta-analysis. J Am Acad Dermatol. 2017 Jul;77(1):70-8.[Abstract]
29. Lukács J, Schliemann S, Elsner P. Occupational contact urticaria caused by food: a systematic clinical review. Contact Dermatitis. 2016 Oct;75(4):195-204.[Abstract][Full Text]
30. Villarama CD, Maibach HI. Correlations of patch test reactivity and the repeated open application test (ROAT)/provocative use test (PUT). Food Chem Toxicol. 2004 Nov;42(11):1719-25.[Abstract]
31. Wilkinson DS, Fregert S, Magnusson B, et al. Terminology of contact dermatitis. Acta Derm Venereol. 1970;50(4):287-92.[Abstract]
32. Neale H, Garza-Mayers AC, Tam I, et al. Pediatric allergic contact dermatitis. Part I: Clinical features and common contact allergens in children. J Am Acad Dermatol. 2021 Feb;84(2):235-44.[Abstract][Full Text]
33. Neale H, Garza-Mayers AC, Tam I, et al. Pediatric allergic contact dermatitis. Part 2: Patch testing series, procedure, and unique scenarios. J Am Acad Dermatol. 2021 Feb;84(2):247-55.[Abstract]
34. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins--Gynecology. Diagnosis and management of vulvar skin disorders: ACOG practice bulletin, number 224. Obstet Gynecol. 2020 Jul;136(1):e1-14.[Abstract]
35. Mowad CM, Anderson B, Scheinman P, et al. Allergic contact dermatitis: patient diagnosis and evaluation. J Am Acad Dermatol. 2016 Jun;74(6):1029-40.[Abstract]
36. Gupta AK, Chow M. Pimecrolimus: a review. J Eur Acad Dermatol Venereol. 2003 Sep;17(5):493-503.[Abstract]
37. Bhardwaj SS, Jaimes JP, Liu A, et al. A double-blind randomized placebo-controlled pilot study comparing topical immunomodulating agents and corticosteroids for treatment of experimentally induced nickel contact dermatitis. Dermatitis. 2007 Mar;18(1):26-31.[Abstract]
38. Amrol D, Keitel D, Hagaman D, et al. Topical pimecrolimus in the treatment of human allergic contact dermatitis. Ann Allergy Asthma Immunol. 2003 Dec;91(6):563-6.[Abstract]
39. Boelman DJ. Emergency: Treating poison ivy, oak, and sumac. Am J Nurs. 2010 Jun;110(6):49-52.[Abstract]
40. Brasch J, Becker D, Aberer W, et al. Guideline contact dermatitis: S1-Guidelines of the German Contact Allergy Group (DKG) of the German Dermatology Society (DDG), the Information Network of Dermatological Clinics (IVDK), the German Society for Allergology and Clinical Immunology (DGAKI), the Working Group for Occupational and Environmental Dermatology (ABD) of the DDG, the Medical Association of German Allergologists (AeDA), the Professional Association of German Dermatologists (BVDD) and the DDG. Allergo J Int. 2014;23(4):126-38.[Abstract][Full Text]
41. Saary J, Qureshi R, Palda V, et al. A systematic review of contact dermatitis treatment and prevention. J Am Acad Dermatol. 2005 Nov;53(5):845.[Abstract]
42. Lysdal SH, Johansen JD. Fragrance contact allergic patients: strategies for use of cosmetic products and perceived impact on life situation. Contact Dermatitis. 2009 Dec;61(6):320-4.[Abstract]
43. Cohen DE, Heidary N. Treatment of irritant and allergic contact dermatitis. Dermatol Ther. 2004;17(4):334-40.[Abstract]
44. Health and Safety Executive. Managing the risks from skin exposure [internet publication].[Full Text]
45. Marks JG Jr, Fowler JF Jr, Sheretz EF, et al. Prevention of poison ivy and poison oak allergic contact dermatitis by quaternium-18 bentonite. J Am Acad Dermatol. 1995 Aug;33(2 pt 1):212-6.[Abstract]
46. Neill BC, Neill JA, Brauker J, et al. Postexposure prevention of Toxicodendron dermatitis by early forceful unidirectional washing with liquid dishwashing soap. J Am Acad Dermatol. 2019 Aug;81(2):e25.[Abstract]
47. Mostosi C, Simonart T. Effectiveness of barrier creams against irritant contact dermatitis. Dermatology. 2016;232(3):353-62.[Abstract][Full Text]
48. Blauvelt A, Teixeira HD, Simpson EL, et al. Efficacy and safety of upadacitinib vs dupilumab in adults with moderate-to-severe atopic dermatitis: a randomized clinical trial. JAMA Dermatol. 2021 Sep 1;157(9):1047-55.[Abstract][Full Text]
49. Simpson EL, Sinclair R, Forman S, et al. Efficacy and safety of abrocitinib in adults and adolescents with moderate-to-severe atopic dermatitis (JADE MONO-1): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet. 2020 Jul 25;396(10246):255-66.[Abstract]
50. Papp K, Szepietowski JC, Kircik L, et al. Efficacy and safety of ruxolitinib cream for the treatment of atopic dermatitis: results from 2 phase 3, randomized, double-blind studies. J Am Acad Dermatol. 2021 Oct;85(4):863-72.[Abstract][Full Text]
51. Simpson EL, Lacour JP, Spelman L, et al. Baricitinib in patients with moderate-to-severe atopic dermatitis and inadequate response to topical corticosteroids: results from two randomized monotherapy phase III trials. Br J Dermatol. 2020 Aug;183(2):242-55.[Abstract]
52. Nakagawa H, Nemoto O, Igarashi A, et al. Delgocitinib ointment, a topical Janus kinase inhibitor, in adult patients with moderate to severe atopic dermatitis: a phase 3, randomized, double-blind, vehicle-controlled study and an open-label, long-term extension study. J Am Acad Dermatol. 2020 Apr;82(4):823-31.[Abstract][Full Text]
53. ClinicalTrials.gov. JAK1 inhibitor with medicated topical therapy in adolescents with atopic dermatitis (JADE TEEN). April [internet publication].[Full Text]
54. Johnson H, Adler BL, Yu J. Dupilumab for allergic contact dermatitis: an overview of its use and impact on patch testing. Cutis. 2022 May;109(5):265-7.[Abstract]
55. Stout M, Silverberg JI. Variable impact of dupilumab on patch testing results and allergic contact dermatitis in adults with atopic dermatitis. J Am Acad Dermatol. 2019 Jul;81(1):157-62.[Abstract]
56. Raffi J, Suresh R, Botto N, et al. The impact of dupilumab on patch testing and the prevalence of comorbid allergic contact dermatitis in recalcitrant atopic dermatitis: a retrospective chart review. J Am Acad Dermatol. 2020 Jan;82(1):132-8.[Abstract]
57. Taylor S, Grimes P, Lim J, et al. Postinflammatory hyperpigmentation. J Cutan Med Surg. 2009 Jul-Aug;13(4):183-91.[Abstract]
58. Lee JH, Ahn BJ, Noh M, et al. Patch test reactions in patients with the additional diagnosis of vitiligo. Int J Dermatol. 2014 Feb;53(2):187-91.[Abstract]
59. Cork MJ, Danby S. Aqueous cream damages the skin barrier. Br J Dermatol. 2011 Jun;164(6):1179-80.[Abstract]
Key Articles
Other Online Resources
Referenced Articles
Guidelines
Diagnostic
Summary
US pediatric data have shown the top allergens to be metals, fragrances, topical antibiotics, preservatives, and emollients. These trends are important to recognize to guide management and accurate diagnosis.Published by
American Academy of Dermatology
Published
2021
Summary
The Pediatric Baseline Series was developed in 2018 through expert consensus and includes relevant pediatric allergens that dermatologists can use in practice.Published by
American Academy of Dermatology
Published
2021
Summary
Recommendations for the diagnosis of contact dermatitis of the vulva.Published by
American College of Obstetricians and Gynecologists
Published
2020 (reaffirmed 2022)
Summary
Once patch testing has been performed, the education and management process begins. After the causative allergens have been identified, patient education is critical to the proper treatment and management of the patient.Published by
American Academy of Dermatology
Published
2016
Summary
Addresses advances in the field of contact dermatitis and outlines recommendations for optimal methods of diagnosis based on a systematic literature review. Consensus expert opinion and workgroup-identified supplementary documents were utilized when published evidence was lacking.Published by
American Academy of Allergy, Asthma & Immunology (AAAAI); American College of Allergy, Asthma & Immunology (ACAAI); Joint Council of Allergy, Asthma & Immunology
Published
2015
Summary
Clinical features are unreliable to distinguish between allergic contact dermatitis, irritant contact dermatitis, and endogenous eczema.Patch testing is recommended for patients with persistent eczematous eruptions when contact allergy is suspected or cannot be excluded.Published by
British Association of Dermatologists
Published
2017
Summary
Summarizes all aspects of patch testing for the diagnosis of contact allergy in patients that have, or are suspected of having, allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions.Published by
European Society of Contact Dermatitis
Published
2015
Treatment
Summary
Recommendations for the management of contact dermatitis of the vulva.Published by
American College of Obstetricians and Gynecologists
Published
2020 (reaffirmed 2022)
Summary
Includes evaluation of patients, indications for patch testing, proper testing procedure, alternative diagnostic tools, and new and emerging allergens.Published by
American Academy of Dermatology
Published
2016
Summary
Outlines recommendations for optimal management of contact dermatitis based on a systematic literature review.Published by
American Academy of Allergy, Asthma & Immunology (AAAAI); American College of Allergy, Asthma & Immunology (ACAAI); Joint Council of Allergy, Asthma & Immunology
Published
2015
Summary
Management of irritant contact dermatitis involves avoidance, protection, and substitution of the irritant.Allergic contact dermatitis requires identification of the allergen and avoidance of the allergen where possible.First-line treatments include topical corticosteroids, soap substitutes, and emollients.Second-line treatments include psoralen plus ultraviolet A, azathioprine, and cyclosporine.Published by
British Association of Dermatologists
Published
2017